Georgia is a beautiful state to live in – but life can certainly be less than peachy if you’re living it without adequate health insurance. Unfortunately, health insurance is very expensive. For millions of Americans, it is prohibitively expensive. So what are your options? Your first step can and should be to shop around the Health Insurance Marketplace for a subsidized plan. But what if you still can’t afford one? Believe it or not, you do have other options. Keep reading if you want to learn more about what those options are, and what you can do to find the most affordable health insurance possible.
Major Medical Insurance in Georgia
Back in the spring of 2010, The Affordable Care Act became the official law of the land. In essence, the legislation made it easier for tens of millions of Americans to find affordable and comprehensive major medical health insurance thanks to federal subsidies for qualifying applicants. But there have been some recent changes in the law which can make it easier to find the health insurance you need at a cost you can afford.
Your first step is to fill out an application at HealthCare.gov during the annual Open Enrollment period. Open Enrollment typically lasts from November 1st to December 15th, but many applicants can qualify for a special enrollment period based on extenuating life circumstances. Once you fill out your application, you will receive correspondence that lets you know if you are eligible for a subsidy, how much of a subsidy you are eligible for, and you can start shopping the Exchange for a health plan which best suits your needs.
Why should you start with HealthCare.gov and the Exchange as opposed to shopping for other options? For one, the major medical policies on the Exchange are all guaranteed issue. This means that if you apply for coverage, the health insurance company you apply to must sell you a policy – they cannot refuse or deny you. And when it comes time to calculate your monthly premium, the only factors which your insurance company is allowed to take under consideration are:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
With each guaranteed issue policy comes another major benefit: the 10 guaranteed Essential Health Benefits which are legally required to be incorporated into every single health insurance policy sold on the Exchange. Those 10 benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
The closing argument that seals the deal for most people with regard to ACA major medical health insurance is the federal subsidy. As long as you are making at least 138% of the federal poverty limit, you can qualify to have a substantial portion of your monthly premium taken care of by the federal government. The chart below clearly outlines the income thresholds based on household size to make it easier for you to figure out if you qualify for a subsidy within the state of Georgia:
|Annual Income (138% of FPL)
|Annual Income (100% of FPL)
But what happens if you don’t make at least 138% of the federal poverty limit? Well, if you make 100% or below the federal poverty limit, you may qualify for Medicaid – although some restrictions apply. And if you are in the gap between 100% and 138% of the federal poverty limit, then you will most likely have to look for other options. Unfortunately, Georgia still refuses to accept federal funds which could expand Medicaid for people who exist in this income gap. So until state legislators change their minds and decide to accept funding to help their most needy citizens get the health insurance they require, you will have to explore other options such as short-term health insurance, health share plans, or fixed indemnity insurance, just to name a few.
Short Term Health Insurance in Georgia
If you happen to fall into the income coverage gap mentioned above, or if you are below the federal poverty limit but do not qualify for Medicaid in Georgia, then the first option you might want to consider is short-term health insurance. Although these plans don’t technically count as “real” health insurance according to the federal government, that classification is only really important with regard to the individual mandate – which no longer exists in the state of Georgia. Short term health insurance can be a very viable option if you need a low-cost, rainy day insurance policy to protect yourself from the most catastrophic of health emergencies. But such plans aren’t without their disadvantages.
Out of all the ACA alternative health plans out there, you will get the greatest consumer protections from short-term health insurance. This means that if you are ever in a dispute over a claim with your insurance provider, you will have a substantial amount of legal recourse to take them to court and get them to pay you what you are owed. You can also customize your coverage to a certain extent, which will help you get you as close to receiving the 10 guaranteed Essential Health Benefits as you can get outside of the Health Insurance Marketplace. You won’t have to submit your personal information to HealthCare.gov, because you’ll be applying for coverage directly from the company who is offering you the policy. Best of all, these plans can cost up to 33% less in monthly premiums than an unsubsidized ACA health insurance policy.
So that’s the good news. But there is some not-so-good news you should know about before you decide on short-term health insurance. These plans will not guarantee you the same Essential Health Benefits that you would be guaranteed under the ACA. So if you require care that most insurance companies don’t want to provide – like preventative care, or mental health counseling – you might not be able to get that coverage with short-term health insurance. There is also medical underwriting, which means you don’t get the guaranteed issue protections that you would get under the ACA. So if you have a pre-existing condition that your insurance provider doesn’t like, they could charge you astronomically high monthly premiums – or they could refuse to sell you coverage at all if that is their prerogative. Short-term health insurance plans only last 36 months maximum, so every three years you will have to undergo more medical underwriting and you may get charged more or have your health insurance provider refuse to renew your coverage. Lastly, the vast majority of these plans are high deductible plans, meaning that you will have to pay for most of your medical expenses up front and out-of-pocket – as much as $5,000 or more – before your provider will start paying out claims.
Christian Health Plans/Health Share Plans in Georgia
Another option you might want to consider aside from short-term health insurance is a health sharing plan, also commonly referred to as a Christian health plan. If a federal mandate to purchase coverage were still the law of the land, a Christian health plan would qualify as a viable exemption because of its religious nature; however, like short-term health insurance, it is not necessarily equivalent or adequate coverage when compared to plans sold on the federal Exchange.
When compared to full price ACA plans, health share plans are considerably cheaper and usually on par with short-term health insurance. But you should know that health share plans come with the following caveats:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include guaranteed Essential Health Benefits
You should also know that Christian health plans are subjected to absolutely no federal oversight whatsoever. This basically means they can do whatever they want, including denying you the benefits they originally promised and rejecting your medical claims without reason. Unlike with short-term health insurance, you don’t have any legal recourse if you happen to fall in with a health share plan provider who doesn’t make good on their promised benefits. The lingo for these plans is a little different, also. Your monthly premium is actually a “monthly shared amount”, and you will be paying a “personal responsibility amount” or an “unshared amount” instead of co-pays, deductibles, or co-insurance. Because the vast majority of these organizations are religious in nature, you will likely have to follow specific participation guidelines which are biblically-based. Some of these guidelines include the cessation of tobacco use, abstention from other unhealthy activities like alcohol consumption, and you will likely be required to declare a specific faith. For some people, however, the affordability of these plans makes all of the extra stipulations worth it.
Fixed Indemnity Plans in Georgia
Most of the time, fixed indemnity plans – weather for doctor visits, or hospital insurance – are supplements which are meant to go alongside a major medical plan. They aren’t typically sold by themselves or as a replacement for major medical insurance. Like many of the options on this list so far, they would not qualify as adequate coverage to exempt you from an individual mandate if one still existed. But that doesn’t mean these fixed indemnity plans cannot help alleviate the financial burden of necessary medical care.
Part of the reason they can’t qualify as adequate replacement coverage is because they’re not guaranteed issue, and they do not guarantee you the same 10 Essential Health Benefits that an ACA plan will. But they can help make the care you receive more affordable by paying out on a per event, per visit, or per unit of time (month/week/day) basis. Because these plans come with relatively low monthly premiums, it makes this type of coverage a good option both as a supplement to more comprehensive coverage and as a way to protect yourself from medical costs climbing out of control if you don’t have coverage at all.
Discount Cards in Georgia
In case you were wondering, no, medical discount cards do not count as an adequate replacement for major medical coverage, either. But they can help take the edge off of your total medical costs at the register. Medical discount cards are membership programs that you pay a monthly or yearly fee to be a part of. You will receive a card in the mail once you sign up, and then you can use it at any participating provider when you fill a prescription, go to an eye appointment, visit to the dentist, or anywhere else your medical discount card is accepted. There are no claims to file, and no reimbursements to receive. But you will get a potentially substantial discount when you pay for medical services.
Before you go run out and purchase the first medical discount card you find, however, we strongly suggest you do some research first. There are federal laws as well as some state regulations which govern how these companies can act – but that doesn’t always stop bad actors from slipping through the cracks. Some companies will exaggerate or even fabricate the amount of discounts offered or the providers who have agreed to participate in their program in order to get more business. If you want to protect yourself from this type of fraud, be sure to follow up and double-check with participating providers before you sign up with a particular medical discount card company. If you find a good deal that checks out, these cards can be a great way to curb the rising cost of out-of-pocket medical expenses.